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HomeMy WebLinkAboutT13N R3W SEC 13 Lot 6 of 49LoT G~TER ANCHORAGE AREA BORO~-"-~H HEALTH DEPARTMENT $27 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM N? 361 SEPTIC TANK: DISTANCE FROM WELL ~'~//~'~"/~?~ LIQUID CAPACITY /~) ~z~ ~ GALLONS. MAILING ~ , ADDRESS~.~,b'~ ~ .~/~ PHONE LEGAL DESCRIPTION- ~- ~' ~ ~'~.' NUMBER OF MATERIAL -~ COMPARTMENTS INSIDE LENGTH. ~ INSIDE WIDTH ~ DE~TH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PiT: ~-~- ~",-'---r~'-'/,,'( / OUTSIDE DIAMETER OR WIDTH ~y~//~//~'/~'~/~/~/' DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA). , LENGTH ~ DEPTH BUILDING FOUNDATION SQ. FT. TIL~E DRAI~N FIELD~.. ~ ~ TOTAL LENGTH D I STA N C E F R O~l/ ,FOUNDATION ~ , NEAREST LOT LINE , OF LINES . NUMBER OF/~NES DISTANCE BETWEEN LINES % TRENCH WIDTH ~CTIVE OEJPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE-- / DISTANCE FROM ~-~WATER ~ NEAREST WELL: TYPE//~/.~/-~'~ . DEPTH , BUILDING FOUNDATION. SAMPLE OTHER z~.~ ~ SEPTIC ~ SEEPAGE ~ CESSPOOl ~ SOURCES NEAREST LOT LINE /. SEWER LINE , TANK , SYSTEM DISTANCES: DIAGRAM OF SYSTEM APPROVED GREATEI~'ANCHORAGE AREA '_ '~)ROUGH c,seNo.,~ HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 /(~,,.~ O SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH :///4 PERCOLATION TEST RESULTS NAME OF APPL'CANT c, :4//C-MA,,,NGAD RESS Z RES,O~NCE AODRESS LOCAT,ON OF ,NSTALLAT, ON T O.E'"STALLEO"Y BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS 'Y~/'/~k~ '~1-/'~ L ~fi , PERMIT TO INSTALL A AS DESCRIBED BELOW. SiZE OF UNIT TO BE SERVED SEPTIC TANK SIZE -~/~/_~--~.1 dk~'"'"¢"-~'~ · ,TYPE /T?-~ SEEPAGE AREA~"~.~. DIAGRAM OF SYSTEM TYPE DISTANCES: c ;-I'7 certify that I am familiar with the requ~ements of Greater Anchorage~ugh Ordnance No. 28-68 and that the above described ,system is in accordance with said code. ~ FHA Farm 2573 Rev. July 1958 Form Approved U. S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Budget Bureau No, 63.R0296 FEOERAL HOUSING AD/~INISTRATION HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART L--TO BE COMPLETED BY FHA MO TGAGEE SERIAL NO. Anchorage, Alaska MORTGAGOR OR SPONSOR Richard E. Noble SUBDIVISION NAME Lot 6, Gov. TOTAL NUMBER: PROPERTY ADDRESS 228 Alaska Place ©Yes r No I WATER SUPPLY BY: [~Public system JBLOCK NO. LOT NO. additional bedrooms? ~lf Yes, how rnanyt) SYSTEM DESIGNED FOR [] Community system [] Individual No. o, ,o.*s. O^.^OE D,S,OS^L SEWAGE DISPOSAL [] Public system [] Community system [] Individual 3 [] Yes [] No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [] County [] Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. PUBLIC WATER It is the opinion of the [] State [] County tern with proper maintenance: . [~Can be expected to function satisfactorily, and ~s not likely to create an insanitary condition DATE JaR. [] Local Department of Health that this individual sewage-disposal sys- ]Cannot be expected to function satisfactorily IS'GNATU"E .." / R / /// /) lT,TLE 13, 1971 J ~ I. ~ ,~nvironmental Health Supervisor NOTE: The health autho/dty sh/~uld complete the appropriate opinion statement above and affix date, signature end title in the spaces provided. USO of the above grid for H~//aJth Deportment Inspector's sketch us well as use of the back of this form is at the option of the health authority. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. SIGNATURE CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT DATE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2o~o Ray. July 1958